Healthcare Provider Details

I. General information

NPI: 1679501167
Provider Name (Legal Business Name): JOSEPH M LOMBARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 GRASSLANDS RD
VALHALLA NY
10595-1652
US

IV. Provider business mailing address

95 GRASSLANDS RD
VALHALLA NY
10595-1652
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7389
  • Fax:
Mailing address:
  • Phone: 914-493-7389
  • Fax: 914-493-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA04569300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number255714
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: